Browse the healthcare form templates

Need some help getting started with Hush Secure Forms? We have a collection of healthcare form templates you can use as a starting point for your form. It’s a great way to find inspiration, or to find a completed template that already works for your business.

Hush Secure Forms is our secure, digital alternative to old-fashioned paper forms. You can launch a beautiful, personalized web form for your business in minutes with our drag-and-drop form builder, template directory, and built-in secure web hosting.

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Request an Appointment (Behavioral Health)

A counseling appointment request form. You can link to this form from your website, social media, and email signature. Your customers can use the form to request an appointment with you.

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Intake Form (Adult)

A general intake form for adult clients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Intake form (Child)

A general intake form for child clients. You can send this questionnaire to the parents or guardians of your new clients, to be completed prior to their first appointment.

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Client Experience Survey

A client experience survey. After an appointment, send this survey to your clients to find out what went well, and how they think you can improve.

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Patient Health Questionnaire (PHQ-9)

PHQ-9 is a questionnaire used by qualified professionals to help diagnose, monitor and measure the severity of depression.

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Dental Intake Form

A new dental patient form for your dental practice. You can send this form to your patients prior to their first appointment.

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Request an Appointment (Dental)

A dental appointment request form. You can link to this form from your website, social media, and email signature. Your customers can use the form to request an appointment with you.

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General Anxiety Disorder (GAD-7)

GAD-7 is a questionnaire which can be used by qualified professionals to help diagnose, monitor and measure the severity of anxiety.

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COVID-19 Screening Questionnaire

A COVID-19 screening questionnaire for your clients to complete before their appointment. You can modify the form as needed to comply with local health advice.

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Depression Anxiety Stress Scales (DASS)

The DASS is a 42-item questionnaire designed to help qualified professionals measure the three related negative emotional states of depression, anxiety and tension/stress.

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Depression Anxiety Stress Scales (DASS-21)

The DASS-21 is a 21-item questionnaire designed to help qualified professionals measure the three related negative emotional states of depression, anxiety and tension/stress.

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Massage Therapy Intake Form

An intake form for massage therapy patients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Chiropractic Intake Form

An intake form for chiropractic clients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Physical Therapy Intake Form

An intake form for physical therapy clients. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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PTSD Checklist for DSM-5 (PCL-5)

The PCL-5 is a questionnaire used by qualified professionals to help diagnose, monitor and measure the severity of PTSD. Includes support for the optional LEC-5 and Criterion A formats as well as monthly and weekly formats.

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Alcohol Use Disorders Identification Test (AUDIT)

AUDIT is a questionnaire which can be used by qualified professionals to identify people who would benefit from reducing or ceasing alcohol consumption.

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Therapy Intake Form (Adult)

An intake form for your therapy clients to be completed by adults. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Therapy Intake Form (Child)

An intake form for your therapy clients to be completed for the child. You can send this questionnaire to your new clients, to be completed prior to their first appointment.

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Try Hush Secure Forms risk-free for 60 days

Hushmail for Healthcare includes Encrypted Email, Secure Web Forms, a Private Message Center, and optionally Electronic Signatures. We'll include a signed Business Associate Agreement (BAA) and Email Archiving to help with your HIPAA compliance.

Overview

Starter

$
9.99
per month

Recommended

$
19.99
per month

Custom

Please contact us for custom pricing

Encrypted email accounts 1 Up to 5 Up to
Secure web forms Up to 2 Up to 5 Up to
Electronic signatures Not included Included Included
Private message center Included Included Included
Business Associate Agreement HIPAA Included Included Included
60-day money back guarantee Included Included Included
Form building credit Bonus $50 $100 $100 $200
Encrypted Email
Webmail (desktop & mobile) Included Included Included
Works with email apps (e.g. Outlook) Included Included Included
Hushmail for iPhone Included Included Included
Custom domain (@yourcompany.com) Included Included Included
Send & receive encrypted file attachments Included Included Included
Email aliases Unlimited Unlimited Unlimited
Storage (per email account) 10 GB 15 GB 15 GB
Secure Web Forms
Monthly form submissions Unlimited Unlimited Unlimited
Maximum pages per form Unlimited Unlimited Unlimited
Ready-made form templates Included Included Included
Calculated questionnaires (e.g. PHQ-9) Included Included Included
Design your own forms Included Included Included
Receive form submissions as PDFs Included Included Included
Conditional field visibility Included Included Included
Share forms with colleagues Not included Included Included
Body charts Not included Included Included
Electronic Signatures
Sign on desktop and mobile Not included Included Included
Detailed activity records Not included Included Included
ESIGN and UETA compliant Not included Included Included
One signer per form Not included Included Included
Multiple signers per form Not included Not included Coming soon
Private Message Center
Maximum clients per month Unlimited Unlimited Unlimited
Clients can send secure replies Included Included Included
Automatically expiring messages (2 weeks) Included Included Included
Customization & Branding
Custom logo Not included Included Included
Custom secure web form accent color Not included Included Included
Remove Powered by logo from forms Not included Not included Included
Customer Care
One-on-one setup assistance by phone Included Included Included
Technical support by phone and email Included Included Included
Online knowledge base Included Included Included
Security & Compliance
Business Associate Agreement HIPAA Included Included Included
Email archiving HIPAA Included Included Included
Information Manager Agreement (Canada) Included Included Included
Two-step verification Included Included Included
Encryption OpenPGP & SSL OpenPGP & SSL OpenPGP & SSL
Domain Administration (if using a custom domain)
Standard email forwarding Included Included Included
Catch-all email forwarding Included Included Included
Manage user accounts Not included Included Included

All prices displayed are in US dollars. Taxes may apply. Full refund if you cancel within 60 days.

Hushmail for Small Business includes Encrypted Email, Secure Web Forms, a Private Message Center, and optionally Email Archiving and Electronic Signatures.

All prices displayed are in US dollars. Taxes may apply.

Hushmail for Law includes Encrypted Email, Secure Web Forms, a Private Message Center, and Email Archiving, and optionally Electronic Signatures. Plus, we'll sign an agreement with customers in the U.S., Canada and the U.K. to seek judicial protection for the account, if necessary, on the basis that the contents are privileged, providing extra protection for your communications.

All prices displayed are in US dollars. Taxes may apply.

Hushmail for Personal Use includes Encrypted Email, Secure Web Forms, and a Private Message Center, with an email address ending in , , , or . Custom email domains are not available on this plan.

All prices displayed are in US dollars. Taxes may apply.

From the Blog

Make a secure fillable online form in minutes

Published on September 16, 2021

Hush Secure Forms is a robust form builder that allows you to give your clients forms they can fill out at home. Here are the basics of building a form along with a downloadable cheat sheet. Read more.